Noncardiac chest pain managed primarily by cardiologists

Cardiologists manage about half of the diagnosed noncardiac patients, and prefer to send those referred to a primary care physician rather than a gastroenterologist, finds the latest issue of the Journal of Clinical Gastroenterology.

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The current assumption is that noncardiac chest pain patients diagnosed by a cardiologist are commonly referred to a gastroenterologist for further evaluation.

Thus far, there are no studies that assess the clinical approach and referral patterns of cardiologists when evaluating subjects with non-cardiac chest pain.

Dr Wai-Man Wong and colleagues determined the extent of involvement of cardiologists in the management of non-cardiac patients.

Cardiologists were randomly selected from the American College of Cardiology national membership list.

The researchers sent the cardiologists a 20-item questionnaire.

29% of noncardiac chest pain patients were followed up by a gastroenterologist clinic

Journal of Clinical Gastroenterology

The questionnaire included questions on demographic information, characteristics of practice, preferences of diagnostic tests, referral patterns, and treatment plans.

A total of 246 cardiologists returned the questionnaire, giving a 33% response rate.

The team reported that a mean of 13% of patients were diagnosed with noncardiac chest pain and 46% were treated by a cardiologist in the past 6 months.

Of the noncardiac chest pain patients that were referred, the researchers noted that 46% ended up in the primary care physician clinic.

The researchers noted that 29% of these patients were followed up by a gastroenterologist clinic.

The team found that 35% of cardiologists are comfortable with diagnosing noncardiac chest pain.

A further 43% of cardiologists are very comfortable with diagnosing noncardiac chest pain.

The team observed that proton pump inhibitors, lifestyle modifications, and
H2 blockers are the most common therapies for noncardiac chest pain.

Dr Wong's team commented, “Cardiologists manage about half of the diagnosed noncardiac patients by themselves.”

“Of those noncardiac patients that are referred, cardiologists prefer to send them to a primary care physician rather than a gastroenterologist.”